Alcohol stands as the most widely accepted drug in society, often serving as the social glue at various gatherings, from weddings and birthday celebrations to diplomatic events; alcohol consistently plays a role in the collective.
However, alcohol raises significant public health concerns. It’s the third leading cause of preventable deaths in the U.S., contributing to car and domestic accidents and a range of diseases, including cardiovascular issues, liver disease, cancer, and fetal alcohol syndrome.
As alcohol use disorder (AUD) doesn’t progress overnight, read on to learn about alcoholism stages, how to recognize them and the steps you can take to intervene effectively.
Table Of Contents:
What is Alcohol Use Disorder?
Alcohol use disorder (AUD) is a common, chronic, and high-relapsing psychiatric condition in the U.S. marked by compulsive and unhealthy drinking habits. Excessive alcohol consumption is considered an addiction due to:
- Individual loss of control over intake
- Use despite adverse social, occupational, or health consequences.
- Presence of negative feelings in the absence of alcohol
- Unsuccessful attempts to cut down or control alcohol intake
According to the 2022 National Survey on Drug Use and Health (NSDUH), in the U.S., 10.5% of Americans aged 12 and older had AUD in the past year, causing more than 85,000 deaths annually due to alcohol-related issues. Currently, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides criteria for diagnosing AUD, ranging from mild to severe, based on the number of symptoms present that will be further discussed.
Alcohol Use Disorder Diagnosis Criteria
According to the DSM-5, healthcare professionals can diagnose an individual with AUD based on the presence of two or more of the following criteria within 12 months:
- Alcohol intake in larger amounts or over a longer period than intended
- Persistent desire or unsuccessful attempts to cut down or control use
- Significant time spent obtaining, using, or recovering from alcohol
- Craving or a strong urge to drink alcohol
- Failure to achieve important responsibilities due to alcohol use
- Continued alcohol use despite social or interpersonal problems
- Quitting important social, work or recreational activities due to alcohol use
- Alcohol use in physically hazardous situations
- Continued alcohol use despite persistent physical or psychological problems
- Tolerance (increasing alcohol needed for the same effect or reduced effects from the same amount)
- Withdrawal symptoms or using alcohol to relieve or avoid withdrawal symptoms
The severity of AUD is categorized as mild (2-3 criteria), moderate (4-5 criteria), or severe (6 or more criteria) based on the number of criteria met.
Alcoholism Stages − From Experimentation to Addiction
Alcohol’s impact on the brain is the key to understanding how this disorder progresses over time.
Initially, it triggers pleasurable sensations and dampens negative emotions, creating a consumption cycle driven by the desire for these effects. However, continued use can lead to alterations in brain structure and function, amplifying vulnerability to addiction. As these changes persist even after zero alcohol intake, the risk of relapse is present.
Stage 1: Experimentation
Those struggling with AUD usually had their first exposure to alcohol during their teenage years, driven by curiosity or peer influence
In this stage, individuals engage in binge-drinking episodes rather than occasional drinking, often during social gatherings or group activities. Only some DSM-5 criteria may be met. Indicators of alcohol misuse, such as experiencing vomiting or even coma due to binge drinking, can occur.
This is an experimental phase, where individuals test their limits and boundaries with alcohol.
Stage 2: Higher Alcohol Tolerance Levels
In the second stage, individuals start to develop a higher tolerance, requiring more alcohol to feel its effects. This leads to increased alcohol consumption and cravings, as well as a greater risk of binge drinking, and can be considered a moderate case of alcohol abuse.
There is an evident dependence on alcohol to cope with stress or discomfort. In this phase, the most dangerous factor here is the potential alcohol habit formation that ultimately contributes to compulsive alcohol use. When left untreated, an alcohol addiction may develop.
Stage 3: Negative Affect/Withdrawal
In the third stage of alcohol addiction, individuals have increased beyond moderate levels but have not reached severe dependence.
Here, the impact of alcohol on daily life becomes more apparent, with friends and family noticing changes in behavior and lifestyle. Negative health consequences may also appear more prominently. Individuals in this stage meet at least four to five criteria from the DSM-5 list, indicating a progression toward severe alcohol use disorder.
The symptoms present in this stage may be:
- Physical (sleep disturbances, pain, feelings of illness)
- Emotional (dysphoria, irritability, anxiety, and emotional pain)
Stage 4: Alcohol Dependence
Individuals are on the brink of alcohol use disorder, with drinking firmly rooted in their daily routines. Despite awareness of the adverse effects, there is a struggle to abstain from alcohol.
There is higher tolerance and dependence with the most severe physical damage to the body. Attempts to quit may trigger withdrawal symptoms. Individuals in this stage meet at least five to six criteria from the DSM-5 criteria, indicating a significant progression toward severe alcohol use disorder.
The symptoms present in this stage may be:
- Body tremors
- Severe irritability
- Racing heartbeats
- Nausea (without a hangover)
- Sleep apnea
Stage 5: Alcohol Use Disorder
This stage marks the culmination of alcohol addiction, where drinking transitions from pleasure to necessity, and individuals present every symptom of the DSM-5 criteria. Constant alcohol cravings control thoughts, and even small quantities of alcohol can’t offer the same level of satisfaction as before.
In this desperate state, individuals may neglect work, self-care and responsibilities and may turn to other substances, such as cannabis or opioids for relief. Common health issues associated with this stage include:
- Guilt
- Loneliness
- Lack of restraint
- Compulsive behavior
- Aggression
- Shakiness
- Cravings
- Anxiety
- Tremors
- Impaired coordination
Alcohol Disorder Self-Assessment Tool
There is no greater tool to diagnose an AUD than a visit to an addiction specialist. Yet, screening tools such as the CAGE questionnaire may be useful in further assessing the likelihood of AUDs. A score of 2 or greater on the CAGE questionnaire typically indicates the need for further evaluation and potential diagnosis of AUDs.
The CAGE questionnaire comprises four questions as listed below:
- Have you ever felt the need to Cut down on your drinking?
- Have you ever been Annoyed by people criticizing your drinking?
- Have you ever felt Guilty about your alcohol consumption?
- Have you ever felt the need for an Eye-opener to steady your nerves or get rid of a hangover?
Alcoholism Stages − Get Professional Help
If, after reviewing the stages of alcohol addiction or the CAGE questionnaire, you or someone you know shows signs of alcohol abuse disorder, seeking professional help promptly is crucial for intervention and recovery.
Alcohol recovery typically involves alcohol detox, medical supervision, therapy, and support groups. Expect withdrawal symptoms, lifestyle adjustments, and emotional challenges. With dedication and support, it’s possible to achieve sobriety and lead a fulfilling life free from alcohol dependence.
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Page Sources
- Alcohol-Related deaths. (2024, April 16). Centers for Disease Control and Prevention. https://www.cdc.gov/alcohol/features/excessive-alcohol-deaths.html
- Becker, H. C. (2008). Alcohol Dependence, Withdrawal, and Relapse. Alcohol Research & Health, 31(4), 348-361. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860472/
- Rapsey, C. M., Wells, J. E., Bharat, M. C., Glantz, M., Kessler, R. C., & Scott, K. M. (2019). Transitions Through Stages of Alcohol Use, Use Disorder and Remission: Findings from Te Rau Hinengaro, The New Zealand Mental Health Survey. Alcohol and Alcoholism (Oxford, Oxfordshire), 54(1), 87-96. https://doi.org/10.1093/alcalc/agy069
- Alcohol Use Disorder (AUD) in the United States: Age groups and demographic characteristics | National Institute on Alcohol Abuse and Alcoholism (NIAAA). (n.d.). https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-use-disorder-aud-united-states-age-groups-and-demographic-characteristics
- The cycle of alcohol addiction | National Institute on Alcohol Abuse and Alcoholism (NIAAA). (n.d.). https://www.niaaa.nih.gov/publications/cycle-alcohol-addiction
- APA Dictionary of Psychology. (n.d.). https://dictionary.apa.org/jellineks-alcoholism-species
